Objective To analyze the risk factors and prognosis of patients with advanced lung cancer complicated with immune checkpoint inhibitor-related pneumonitis(CIP).Methods A total of 220 patients with advanced lung cancer who were treated at Ganzhou Cancer Hospital from January 2022 to October 2024 were selected as the research subjects.The patients were divided into non-CIP group(n=179)and CIP group(n=41)based on whether they had concurrent CIP.Compare the clinical characteristics of two groups of patients and analyze the related influencing factors of patients with advanced lung cancer complicated with CIP.Results There were statistically significant differences in age,gender,underlying pulmonary diseases,smoking history,history of thoracic radiotherapy,treatment plans,serum albumin(Alb),platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR),and absolute lymphocyte count(ALC)between two groups of patients(P＜0.05).Multivariate Logistic regression analysis showed that age,underlying pulmonary diseases,treatment plan,Alb,PLR,NLR,and ALC were all influencing factors for patients with advanced lung cancer complicated with CIP(P＜0.05).The 90-day cumulative survival rate of patients in CIP group was significantly lower than that in non-CIP group(58.54％ vs.77.09％,x2=5.918,P=0.015).With the increase of CIP classification,the 90-day cumulative survival rate of patients showed a downward trend(P＜0.05).Conclusion The incidence of CIP in patients with advanced lung cancer is relatively high.Age,underlying pulmonary diseases,treatment plan,and levels of Alb,PLR,NLR,and ALC are all influencing factors.CIP can have adverse effects on the prognosis of patients.

Purpose To explore the clinicopathological features,diagnosis and differential diagnosis of mantle cell lymphoma(MCL)with aberrant expression of CD10.Methods 14 cases of MCL with aberrant expression of CD10 were analyzed using hematoxylin-eosin,immunohistochemical stains,in situ hybridization,and fluorescence in situ hy-bridization(FISH)techniques to observe the histological morphology,immunophenotype,and molecular genetic char-acteristics.The relevant literatures were reviewed.Results There were 11 males and 3 females,with a male-to-fe-male ratio of 11∶3.The age ranged from 49 to 80 years,with an average age of 64.4 years and a median age of 64 years.10 cases occurred in lymph nodes,1 case in the nasopharynx,1 case in the right colon,1 case in the right eye-lid,and 1 case in the right testis.According to the Ann Arbor staging system,8 cases were classified as stage Ⅳ and 5 cases as stage Ⅲ,and 1 case with undetermined staging.Histologically,there was diffuse effacement of the normal architecture by tumor cells infiltration.Transparent degenerate small blood vessels and scattered individual epithelial-like tissue cells could be observed in the background.Among them,8 cases(8/14,57.14％)were composed of uni-form small to medium-sized lymphocytes with slightly irregular nuclei,unevenly dispersed chromatin,inconspicuous nucleoli,and scant cytoplasm,along with observable mitotic figures.In 3 cases(3/14,21.43％),the tumor cells were large and markedly pleomorphic,with round or irregular nuclei,prominent nucleoli,frequent mitotic figures,and abundant pale cytoplasm.Tumor cells in 3 cases(3/14,21.43％)were resembling lymphoblasts,characterized by round nuclei,fine chromatin,inconspicuous nucleoli,frequent mitotic figures,and scant cytoplasm.Immunophenotyp-ically,CD21 staining showed residual follicular dendritic meshworks.The tumor cells were diffusely and strongly posi-tive for CD20(14/14),PAX5(7/7),CD5(14/14),Cyclin D1(14/14),SOX11(11/11),and BCL2(13/13),partially positive for BCL6(8/14,57.14％)and MUM1(6/9,66.67％),but negative for CD3(14/14)and CD23(14/14).Among 14 cases,10 cases were diffusely and strongly positive for CD10(10/14,71.43％),and 4 cases were partially positive for CD10(4/14,28.57％).The percentage of Ki67 index ranged from 10％to 90％.All cases were negative for EBER(8/8).FISH analysis was performed in 9 cases,among which 7 cases showed CCND1 gene rearrangement,another 2 cases failed to detect due to insufficient tissue samples.Bone marrow biopsy was performed in 13 cases,revealing involvement in 8 cases(8/13,61.54％)and no involvement in 5 cases(5/13,38.46％).Con-clusion MCL with aberrant expression of CD10 is very rare,which commonly exhibits a diffuse growth pattern and blastoid and pleomorphic variants.It often has a high Ki67 proliferation index and poorer prognosis,and should be dis-tinguished from other subtypes of CD1O-positive B-cell lymphomas.

Purpose To explore the clinicopathological features,diagnosis and differential diagnosis of mantle cell lymphoma(MCL)with aberrant expression of CD10.Methods 14 cases of MCL with aberrant expression of CD10 were analyzed using hematoxylin-eosin,immunohistochemical stains,in situ hybridization,and fluorescence in situ hy-bridization(FISH)techniques to observe the histological morphology,immunophenotype,and molecular genetic char-acteristics.The relevant literatures were reviewed.Results There were 11 males and 3 females,with a male-to-fe-male ratio of 11∶3.The age ranged from 49 to 80 years,with an average age of 64.4 years and a median age of 64 years.10 cases occurred in lymph nodes,1 case in the nasopharynx,1 case in the right colon,1 case in the right eye-lid,and 1 case in the right testis.According to the Ann Arbor staging system,8 cases were classified as stage Ⅳ and 5 cases as stage Ⅲ,and 1 case with undetermined staging.Histologically,there was diffuse effacement of the normal architecture by tumor cells infiltration.Transparent degenerate small blood vessels and scattered individual epithelial-like tissue cells could be observed in the background.Among them,8 cases(8/14,57.14％)were composed of uni-form small to medium-sized lymphocytes with slightly irregular nuclei,unevenly dispersed chromatin,inconspicuous nucleoli,and scant cytoplasm,along with observable mitotic figures.In 3 cases(3/14,21.43％),the tumor cells were large and markedly pleomorphic,with round or irregular nuclei,prominent nucleoli,frequent mitotic figures,and abundant pale cytoplasm.Tumor cells in 3 cases(3/14,21.43％)were resembling lymphoblasts,characterized by round nuclei,fine chromatin,inconspicuous nucleoli,frequent mitotic figures,and scant cytoplasm.Immunophenotyp-ically,CD21 staining showed residual follicular dendritic meshworks.The tumor cells were diffusely and strongly posi-tive for CD20(14/14),PAX5(7/7),CD5(14/14),Cyclin D1(14/14),SOX11(11/11),and BCL2(13/13),partially positive for BCL6(8/14,57.14％)and MUM1(6/9,66.67％),but negative for CD3(14/14)and CD23(14/14).Among 14 cases,10 cases were diffusely and strongly positive for CD10(10/14,71.43％),and 4 cases were partially positive for CD10(4/14,28.57％).The percentage of Ki67 index ranged from 10％to 90％.All cases were negative for EBER(8/8).FISH analysis was performed in 9 cases,among which 7 cases showed CCND1 gene rearrangement,another 2 cases failed to detect due to insufficient tissue samples.Bone marrow biopsy was performed in 13 cases,revealing involvement in 8 cases(8/13,61.54％)and no involvement in 5 cases(5/13,38.46％).Con-clusion MCL with aberrant expression of CD10 is very rare,which commonly exhibits a diffuse growth pattern and blastoid and pleomorphic variants.It often has a high Ki67 proliferation index and poorer prognosis,and should be dis-tinguished from other subtypes of CD1O-positive B-cell lymphomas.

Objective To analyze the risk factors and prognosis of patients with advanced lung cancer complicated with immune checkpoint inhibitor-related pneumonitis(CIP).Methods A total of 220 patients with advanced lung cancer who were treated at Ganzhou Cancer Hospital from January 2022 to October 2024 were selected as the research subjects.The patients were divided into non-CIP group(n=179)and CIP group(n=41)based on whether they had concurrent CIP.Compare the clinical characteristics of two groups of patients and analyze the related influencing factors of patients with advanced lung cancer complicated with CIP.Results There were statistically significant differences in age,gender,underlying pulmonary diseases,smoking history,history of thoracic radiotherapy,treatment plans,serum albumin(Alb),platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR),and absolute lymphocyte count(ALC)between two groups of patients(P＜0.05).Multivariate Logistic regression analysis showed that age,underlying pulmonary diseases,treatment plan,Alb,PLR,NLR,and ALC were all influencing factors for patients with advanced lung cancer complicated with CIP(P＜0.05).The 90-day cumulative survival rate of patients in CIP group was significantly lower than that in non-CIP group(58.54％ vs.77.09％,x2=5.918,P=0.015).With the increase of CIP classification,the 90-day cumulative survival rate of patients showed a downward trend(P＜0.05).Conclusion The incidence of CIP in patients with advanced lung cancer is relatively high.Age,underlying pulmonary diseases,treatment plan,and levels of Alb,PLR,NLR,and ALC are all influencing factors.CIP can have adverse effects on the prognosis of patients.

Purpose To explore the clinicopathological features,diagnosis and differential diagnosis of large B-cell lym-phoma with IRF4 rearrangement(LBCL-IRF4r).Methods Clinical data of 8 cases of LBCL-IRF4r were collect,hematoxy-lin-eosin and immunohistochemical of EnVision two-step stains,in situ hybridization and FISH was used to study the histology,immunotypes and molecular genetic characteristics.The rele-vant literatures were reviewed.Results Among 8 cases of LBCL-IRF4r,the male to female ratio was 1.67:1,with age range 10-53 years(mean 25.8 years).Five cases occurred in tonsils,2 cases in nasopharynx and 1 cases in inguinal lymph node.Microscopically,the tumors presented with a purely follic-ular,purely diffuse or a combined follicular and diffuse architec-ture.The tumor cells were typical centroblasts and less frequent-ly medium-sized blastic cells with smaller nucleoli,apoptosis and nuclear fragmentation were easily seen.Immunophenotypi-cally,the tumor cells of the eight cases of LBCL-IRF4r diffuse strongly expressed CD20(8/8),PAX5(2/2),CD79a(3/3),BCL6(8/8)and MUM-1(8/8),mostly expressed CD10(7/8),partially expressed BCL2(5/8)and CD5(4/8),and did not express Cyclin D1,CD23 and CD30.The percentage of Ki67 index ranged from 70％to 95％.EBER in situ hybridiza-tion was negative in all cases.IRF4 rearrangements were detec-ted in all cases(8/8).BCL6 rearrangements were detected in one case(1/2).MYC(0/4)and BCL2(0/3)rearrangements were not detected in all cases.Conclusion LBCL-IRF4r is more common in children and adolescents with characteristic IG::IRF4 rearrangement and a good prognosis,which needs to be differentiated from other types of large B-cell lymphoma.

Objective:To seek the optimal melanin-removal method for hematoxylin and eosin (HE) staining, immunohistochemistry and molecular detection.Methods:Thirty-eight paraffin tissue samples of malignant melanoma diagnosed at the Fujian Cancer Hospital, Fuzhou, China between January 2018 and March 2022 were collected and used to make a tissue microarray. Melanin in these cases was removed using warm hydrogen peroxide, double oxidation depigmentation, modified potassium permanganate-oxalic acid or trichloroisocyanuric acid, followed by HE staining. The cases were divided into two cohorts: one was subject to the one of the above four methods to remove melanin first, followed by immunohistochemistry (SOX-10, Ki-67, HMB45 and Melan A), while the other was subject to immunohistochemical staining first and then a melanin removal. Following that, seventeen melanin-rich paraffin tissue samples were collected and depigmented using the methods described above. DNA extraction was then done, followed by assessments of DNA content and quality. Moreover, the completeness of melanin removal, the effect on HE and immunohistochemical staining, and the quality of DNA were compared between the depigmented methods.Results:Regarding the effectiveness of melanin removal, the modified potassium permanganate-oxalic acid and the warm hydrogen peroxide methods were the most effective, and both showed residual melanin in only 5.26% (2/38) of the cases. The trichloroisocyanuric acid method showed residual melanin in 10.53% (4/38) of the cases. The worst was the double oxidation depigmentation method, which showed pigment residue in 15.79% (6/38) of the cases. For HE staining, the percentage of good staining with the warm hydrogen peroxide method was 92.11%, higher than the other three methods. For immunohistochemical staining, the mean staining scores of immunohistochemistry first followed by melanin removal with modified potassium permanganate-oxalic acid, double oxidation and trichloroisocyanuric acid were 20.84, 26.63 and 35.02, respectively. These immunohistochemical staining scores were higher than those of melanin removal first followed by immunohistochemistry (8.70, 15.41 and 21.22, respectively). The mean staining score of melanin removal by warm hydrogen peroxide method followed by immunohistochemistry was 33.57, superior to that of immunohistochemistry followed by the melanin removal (19.96). Moreover, the staining scores of HMB45, MelanA and Ki-67 with immunohistochemical staining followed by trichloroisocyanuric acid method were 36.45, 33.79, and 36.24, respectively, while the staining score of SOX10 with melanin removal by warm hydrogen peroxide followed by immunohistochemistry was 34.39. The DNA was significantly degraded by modified potassium permanganate-oxalic acid, double oxidation depigmentation and trichloroisocyanuric acid, whereas the mean concentration of DNA extracted after melanin removal by hydrogen peroxide method was 59.59 μg/L, substantially higher than that of DNA extracted without melanin removal (30.3 μg/L, P=0.001). The A260/ A280 of DNA extracted after melanin removal by hydrogen peroxide was between 1.8 and 2.0 in all cases, and the A260/ A230 was above 2.0 in sixteen cases, suggesting high purity of DNA. However, the DNA extracted without removing the melanin showed poor purity, with A260/ A280 below 1.8 in eight cases and A260/ A230 below 2.0 in sixteen cases. Conclusions:Warm hydrogen peroxide showed the least melanin residue, superior HE staining and a minimal effect on DNA purity/quality compared to the other three methods. It thus appears most suitable for PCR, NGS and other molecular detection. Melanin removal with trichloroisocyanuric acid after immunohistochemical staining has the least melanin residual, and thus could be the most convenient and efficient. However, it is noted that the efficacy of the same depigmentation method varies with different antibodies. Therefore, the optimal depigmentation method should be selected based on the specific markers of interest.

Objective:To explore the genetic etiology of a child with primary hypertrophic osteoarthropathy(PHO).Methods:A child who was admitted to Zhongnan Hospital of Wuhan University on July 27, 2021 was selected as the study subject. Genomic DNA was extracted from peripheral blood samples of the child and his parents and subjected to whole exome sequencing. Suspected splicing variant was verified by Sanger sequencing of family members. In vitro function was validated through a minigene assay, whilst the suspected exonic deletion was validated by long-fragment PCR. This study was approved by the Children′s Hospital Affiliated to Zhengzhou University (Ethics No. 2023-K-011). Results:Whole exome sequencing revealed that the child has harbored compound heterozygous variants of HPGD gene, including a heterozygous deletion (Exon 3 del) derived from his father and a splicing variant (c.421+ 1G>T) derived from his mother. Long-fragment PCR verified that the child and his father had both harbored a 7 565 bp heterozygous deletion (c.218-1304_324+ 6156del), whilst the minigene assay proved that the splicing variant has resulted in skipping of exon 4. Conclusion:The heterozygous c. 218-1304_324+ 6156del deletion and the c. 421+ 1G>T splicing variant of the HPGD gene probably underlay the pathogenesis in this child. Above finding has enriched the mutational spectrum of the HPGD gene and provided a basis for genetic counseling and prenatal diagnosis for this family.

In order to explore the mechanism by which Rehmannia extract enhances ovarian follicle development,reduces ovarian aging,and improves the production performance of chickens,35-week-old black skin and red crest chickens were randomly divided into a blank control group and groups supplemented with 0.1％,0.2％and 0.4％Rehmannia extract for feeding experiments.Changes of histological structure and molecular regulation for improving the reproductive perform-ance of black skin and red crest chicken were explored here by detecting the reproductive hormones and the corresponding receptors in ovary and quantifying the cell proliferation and apoptotic lesion.Based on the PI3K/AKT/mTOR and AMPK signaling pathways,mechanisms of Rehmannia ex-tract on promoting ovarian follicle development and alleviating ovarian aging were further studied to enrich the reproductive regulation theory of native breed chickens and improve their reproduc-tive performance.The results indicated that 0.4％Rehmannia extract could improve the levels of LH,E2 and P4 in serum,elevate the relative expression levels of FSHR,ERβ and PCNA mRNA in ovarian tissues,increase the content of PCNA protein,and decrease the number of apoptosis cells and the level of apoptosis protein Cleaved-Caspase-3.By enhancing the secretion of norepinephrine and activating the a2A-AR and the downstream PI3K/AKT/mTOR signaling pathway in ovary,the Rehmannia extract could effectively relieve the decline of ovarian function and maintain stable and efficient ovarian functions,which was independent of AMPK signaling pathway.Therefore,0.4％Rehmannia extract is conducive to enhancing the reproductive function via regulating PI3K/AKT/mTOR signaling pathway.

Objective:To explore the change and development characteristics of the efficacy of group psychotherapy through the changing process and characteristics of therapeutic factors in dynamic interpersonal group therapy.Methods:Eight patients who volunteered to participate in the group were recruited in the psychological counseling clinic (diagnosed as anxiety and/or depression by psychiatrists and all accompanied with complaints of interpersonal difficulties), and were given dynamic interpersonal group psychotherapy once a week for 24 weeks. After each session, a questionnaire survey was conducted using the simplified version of the structure of Yalom's curative factor scale, and a one-on-one qualitative interview was conducted after 24 group sessions. Using quantitative and qualitative methods, the changes and development of group efficacy and therapeutic factors in the process of group therapy were explored from the perspective of group members.The interview results were encoded and analyzed by rooted theory.Quantitative descriptive statistical analyses were performed using SPSS 23.0, and qualitative statistical analyses were performed using the tool NVivo12.Results:The work efficiency of the group gradually improved with the progress of treatment, and the work efficiency was the highest in the end stage(form stage: 2.9, work stage: 3.0, end stage: 3.2).The efficacy of most therapeutic factors were consistent with the group process.The efficacy of some therapeutic factors, such as universality, guidance and infusion of hope had their own special pattern changes.Conclusions:The focus of different stages of the group therapy was different, and the longer the members participate in the group therapy, the higher their perceived group efficacy. The importance and effectiveness of therapeutic factors have no fixed level and rule, which may be influenced by the nature of the group, the characteristics of the participants and the techniques used by therapists.

Objective:To explore the change and development characteristics of the efficacy of group psychotherapy through the changing process and characteristics of therapeutic factors in dynamic interpersonal group therapy.Methods:Eight patients who volunteered to participate in the group were recruited in the psychological counseling clinic (diagnosed as anxiety and/or depression by psychiatrists and all accompanied with complaints of interpersonal difficulties), and were given dynamic interpersonal group psychotherapy once a week for 24 weeks. After each session, a questionnaire survey was conducted using the simplified version of the structure of Yalom's curative factor scale, and a one-on-one qualitative interview was conducted after 24 group sessions. Using quantitative and qualitative methods, the changes and development of group efficacy and therapeutic factors in the process of group therapy were explored from the perspective of group members.The interview results were encoded and analyzed by rooted theory.Quantitative descriptive statistical analyses were performed using SPSS 23.0, and qualitative statistical analyses were performed using the tool NVivo12.Results:The work efficiency of the group gradually improved with the progress of treatment, and the work efficiency was the highest in the end stage(form stage: 2.9, work stage: 3.0, end stage: 3.2).The efficacy of most therapeutic factors were consistent with the group process.The efficacy of some therapeutic factors, such as universality, guidance and infusion of hope had their own special pattern changes.Conclusions:The focus of different stages of the group therapy was different, and the longer the members participate in the group therapy, the higher their perceived group efficacy. The importance and effectiveness of therapeutic factors have no fixed level and rule, which may be influenced by the nature of the group, the characteristics of the participants and the techniques used by therapists.